Role of the Midwife in Supporting Breastfeeding - Essay Example

Role of the Midwife in Supporting Breastfeeding The practise of breastfeeding is as old as mammalian life on earth. It is still exclusively employed by all mammals other than humans as the way to nourish their young. Because of convenience and in some measure disinformation, formula or ‘bottle’ feeding has become an increasingly popular method by which to feed infant and toddler-aged children. Credible information regarding breastfeeding as well as other pertinent aspects of early motherhood is essential for the good health of the child. Midwives are in a uniquely advantageous position to supply learned information to mothers and have long supported breastfeeding as part of an overall plan for promoting optimal health of the infant. Of course, the midwife fully supports whatever decision the mother makes regarding the specific method of feeding the child. The importance of the experience, knowledge and compassion that the midwife brings to the pre-natal, birthing and after-care stages of early life cannot be understated and has been a crucial part of these processes for a long period of time, possibly originating near the emergence of human-kind. This paper examines the midwife, what they are, what they do and how they can affect the preferred method of breastfeeding and why it is a better option than is formula feeding. It also reveals statistics relating to the prevalence of breastfeeding in the UK, government initiatives promoting the practise, the perceptions and misperceptions of women and the general attitude of the public regarding breastfeeding. The conclusion offers suggestions intended to more effectively promote the practise of breastfeeding now and in the future designed primarily for health care professionals, particularly midwifes, and the government. The Midwife Midwives are specialised, licensed health care professionals who are required to provide care for women prior, during and following the birth of a child. Her responsibilities include delivering the newborn and its care during the first weeks of life in addition to offering advice to women during this time of excitement, anxiety and uncertainty in their life. An overview of the care provided includes ensuring the mother understands the necessary preventative measures taken during pregnancy to increase the odds for a healthy baby, detect atypical circumstances in both mother and baby, react quickly and appropriately during an emergency situation and secure medical assistance if necessary. A formal description of the qualifications necessary to become a midwife is as follows: “A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery” (“Definition of the Midwife”, 2003). The Role of the Midwife The midwife’s responsibility is commonly thought to be the delivery of babies. Though this may be the main event in the process, the role of a midwife is much broader. They care and provide support not only to women and newborn babies but to husbands and family members as well. They are available to all parties of the household during the entirety of the pregnancy, birth and as long as needed thereafter. “She [the midwife] has an important task in health counseling and education, not only for the women, but also within the family and the community” (“Midwifery”, 2001). The midwife is the most visible health care representative for mothers-to-be and is a crucial asset in the NHS. They deliver babies both in homes and in hospitals, work as an instructor and provide family planning and management services. Midwives are highly trained professionals who make an invaluable contribution to healthy outcomes for infants and mother. They have become indispensable in this area as they deliver 75 per cent of all babies born in the UK. Midwife services differ from other healthcare professionals in that they are accountable for client-groups and offer continual care for as much as many months. Because of their close and long-term interactions with the same patients, they are able to forge closer thus more effectual and trusted client-provider relationships. The duties of the midwife includes “antenatal education and preparation for parenthood and extend to certain areas of gynaecology, family planning and child care [and] may practise in hospitals, clinics, health units, domiciliary conditions or in any other service” (“Midwifery”, 2001). Public Health Agenda The UK Baby Friendly initiative sponsored through United Nations Children’s Fund (UNICEF) provides the organisational basis for NHS Trusts implementation of programmes designed to enhance healthy early child development such as Sure Start. By meeting the standards of care outlined by the Baby Friendly guidelines ensures that parents have the ability to make educated decisions regarding the appropriate method by which to nourish their baby. “We help the health services to adopt recognised best practice standards so that all parents are supported to make informed decisions about feeding their babies” (Tappin, 2001). The Baby Friendly Initiative offers many services such as training, support and advice to parents and health care professionals. It also assesses community health services and hospitals prior to bestowing accreditation to these institutions. Health care facilities that pass the minimum standards set by the initiative are allowed to apply to be evaluated and are then eligible to be formally accredited as ‘Baby Friendly’. “Health care facilities which adopt these standards can apply to be assessed and accredited as ‘Baby Friendly’ and by changing their practices, health professionals can give mothers the support, information and encouragement to continue their chosen method of feeding for as long as they wish” (Tappin, 2001). Best practice, as outlined by the Baby Friendly Initiative, includes programmes such as the ‘Seven Point Plan for the Protection’ the ‘Ten Steps to Successful Breastfeeding’ and supporting and promoting ‘Breastfeeding in Community Health Care Settings’. The Initiative assists NHS Trusts as well as other health care services to modify and improve they method that they currently care for mothers who are breastfeeding. Since the best practice standards established by the Baby Friendly initiative was introduced, a dramatically higher percentage of mothers in the UK are breastfeeding their children. Hospitals that have implemented the standards of care as directed by the Baby Friendly Initiative have seen the number of baby’s breastfed from birth increase by at least 10 per cent over a four year period. Hospitals in Scotland experienced and eight per cent increase in the number of breastfed babies in an eight year time frame following the implementation of the Baby Friendly programme. The hospitals that did not adopt the Initiative saw just a two per cent increase over the same time period (Tappin, 2001). Outside the UK, this UN sponsored Initiative has produced similar results. For example, a year-long controlled test of 17,000 mothers with infants in Belarus compared those babies who were born in hospitals that had adopted the Baby Friendly programme against those born in facilities that had not. The study found that those babies who had the benefit of being born at Baby Friendly accredited hospitals in this country were significantly healthier than those who were not. “Exclusive breastfeeding at three months in the Baby Friendly Hospitals was seven times higher than in the control hospitals. At six months it was 12 times higher. The risk of gastrointestinal tract infection was 40 percent lower in the Baby Friendly Hospitals” (Kramer, 2001). Earlier this year, in May, Department of Health (DOH) sponsored the fifteenth annual Breastfeeding Awareness Week which was intended and to a great extent accomplished the goal of raising awareness among health care professionals to the benefits breastfeeding offers to both infants and mothers. The hope is that the health care professionals will further promote the benefits of breastfeeding to their patients. The campaign included television advertising expressly designed for this purpose. “Since 1993 the DOH has coordinated an annual campaign, National Breastfeeding Awareness Week, to highlight that breastfeeding is good for the health of mother and baby. The aim is to get women to recognise their right to breastfeed anytime and anywhere, and for friends, family and health professionals to give support for breastfeeding” (O’Reilly, 2002). The government, in association with the DOH, UNICEF and the NHS, also published an information packet for new mothers that provide useful instructions on the methods of successful breastfeeding techniques that were distributed during Breastfeeding Awareness Week (Kramer, 2001). Breastfeeding The most common characterization of breastfeeding has not been revised for more than 35 years and was coined by the industry that manufactures formula. The terminology ‘exclusive breastfeeding’ offered by the industry described a situation where breastfeeding was exclusively used as the baby’s sole supply of milk, however, other types of foods could be supplemented and still fall under this category. Regrettably, this industry definition is still used today by many researchers and program administrators who have not evaluated recent dialogues on the subject. “Clearly, this definition, which views breastfeeding only as a substitute for formula, not as a maternal or child health issue, is to be avoided and soon forgotten” (Labbok, 2000). The term breastfeeding, in more recent definitions, is used to describe when an infant is breastfed exclusively, on intermittent occasions during a defined period or have ever drank breast milk. The term has also been broken down into more easily identifiable categories. ‘Exclusive breastfeeding’ now is used to describe when breast milk is the only nourishment an infant receives. No other foods whether in solid or liquid form is consumed. ‘Almost exclusive’ is when the infant ingests other sources of nourishment such as solid foods, formula vitamins, etc. on occasion. Full breastfeeding is a term used to define both exclusive and almost exclusive breastfeeding. Partial breastfeeding is split into three separate classes, high, medium and low to describe the percentage of breast milk fed in proportion to other foods. Token breastfeeding is used to describe a situation where no more than 10 per cent of the baby’s diet includes breast milk (Labbok, 2000). Benefits of Breastfeeding Overwhelming scientific evidence has demonstrated that breastfeeding offers an optimal degree of the nutritional requirements for infants. In addition, evidence also shows that formula feeding is linked with many disadvantages for infants and their mothers as well. “Breastfeeding is the healthiest way to feed a baby as it provides a perfect balance of nutrients, which will ensure optimal growth and development. This simple act protects children’s health and saves lives in communities around the world, and it also reduces maternal mortality” (“Breastfeeding”, 2006). Numerous studies have proven the health advantages for infants but what has surprised some are the benefits to breastfeeding mothers who are less prone to become sick than those who do not. Breast milk has all the nutrients babies need to stay healthy and grow. Breastfeeding bolsters a child’s immune system which protects them from contracting several adverse conditions including respiratory and ear infections, allergies, various infections and diarrhea. It also reduces the risk for becoming obesity and developing diabetes and heart disease later in life. Infants who are breastfed develop mental and motor skills at a faster rate than those who are not. What has been known since the beginning of mankind is that breastfeeding creates a strong bond between mother and child, a bond that endures for a lifetime. What may not be as readily recognised by the general public is that breastfeeding delays a subsequent pregnancy which allows mother time to recuperate physically, emotionally and psychologically from the birth which enhances life for mum, baby and other children within the family. Evidence also has shown that the mother lowers her risk to contract osteoporosis, breast and ovarian cancer to a degree proportionate to the length of time the mother breastfeeds (“Breastfeeding”, 2006). Breastfeeding provides numerous health advantages for both baby and mother but what is at times overlooked is the economic benefits. Breast milk is free while formula costs hundreds of pounds during the time span of infant feeding, a burden many new families could do without. Nothing is more natural than breastfeeding but remains a controversial method of feeding, likely because of misleading campaigns by formula makers. Many thousands of years of human history passed before formula was invented which, in itself, proves that it is an effective means to nourish infants. Most health care professionals, researchers and mother time agree that breast milk have proven to be the perfect food for babies. To provide baby with the most optimal beginning in life, evidence has shown that breast milk should be the only food given to babies until they are at least six months old. According to an extensive study at the Chandler Medical Center at the University of Kentucky (U.S.) babies who are breastfed either exclusively or almost exclusively have and intelligence quotient (IQ) that is at least three and as much as five points higher than those who were fed formula. The study also demonstrated that the cognitive abilities of breast fed babies were enhanced. The longer the baby is breastfed, the greater degree of variation in cognition with pre-mature babies showing the most benefit. “This study confirms that nutrients in breast milk and maternal bonding have beneficial effects on IQ. Infants deprived of breast milk are likely to have lower IQ, lower educational achievement, and poorer social adjustment than breast-fed infants” (Franklin, 1999). Researchers of the study theorize the reason for enhanced mental abilities of breastfed babies is that mother’s milk supplies the nutrients necessary for faster development of the juvenile brain. According to the study, “breast milk may support neurological development by provision of long-chain polyunsaturated fatty acids such as docosahexaenoic acid (DHA) and arachidonic acid (AA)” (Franklin, 1999). Breast-feeding is better than formula for infants and their mothers for two central reasons, this natural method provides has a higher nutritional value and a bonding experience which has proven to enhance the lives of both mother and child. The heightened nutrition factor alone accounts for more than three full IQ points and bonding adds another two on average. This enhanced intelligence was detected in infants as young as six months, an advantage which was maintained through the teenage years, the last age period examined by the Chandler study. “The study included 20 published reports that met the criteria for the meta-analysis. The analysis accounted for such factors as the mother’s age and intelligence, birth order, race, birth weight, gestational age, and socioeconomic status” (Franklin, 1999). The study found that intelligence increases proportionately to the length of time a baby is breast-fed. As the study explains, the contents of the brain are 60 per cent lipid. DHA and AA make up the majority of lipid in the brain. A mother’s body produces greater amounts of lipid while pregnant and much of this excess is passed on to the child via first the umbilical cord then through the mother’s milk. This chemical-based explanation provides further scientific, peer-reviewed evidence that breast milk is superior to formula, that the natural nourishment is by far the preferred method. Breastfeeding toddler-aged children is a somewhat controversial activity but is widely recommended because of the nutritional value and bonding benefits, the same as for infants. “Mothers breastfeed their toddlers for many of the same reasons they breastfeed their infants: they recognise their children’s needs, they enjoy the closeness, they want to offer comfort, and they understand the health benefits” (“What are the Benefits?”, 2005). The American Academy of Pediatrics has recommended that mothers breastfeed for “at least the first year of life and beyond for as long as mutually desired by mother and child” (“What are the Benefits?”, 2005). UNICEF and The World Health Organization goes further with its recommendation, that children be breastfed up to and past the two-year mark. The controversy surrounding toddler breastfeeding concerns the child becoming overly dependent on the mother at a relatively late age. Some credible professionals fear that toddlers who have yet to be weaned may experience unnecessary impediments while striving to be independent, a natural progression for this age group. However, studies have shown that it’s the children who have been encouraged to become independent too soon who are the ones who usually exhibit fearfulness to a greater extent and tend to cling to mother for a longer period of time. The toddler that breastfeeds does not experience separation anxiety because their dependency desires are being met. “The closeness and availability of the mother through breastfeeding is one of the best ways to help toddlers grow emotionally” (“What are the Benefits?”, 2005). Toddlers learn discipline by breastfeeding too. Teaching discipline to children involves giving instructions regarding what is right and wrong. Punishing the toddler for normal behaviour produces only negative results. For toddlers to readily accept discipline, they must have a positive attitude about themselves and their immediate environment. The act of breastfeeding not only provides needed nutrition, it helps the toddler develop a positive outlook because their emotional needs are being attended to. Breast milk continues providing young children immunity from diseases and supplies needed vitamins after infancy. “If your toddler does get sick, nursing will help comfort him. In fact, a toddler with an upset stomach may be able to tolerate nothing but human milk” (“What are the Benefits?”, 2005). Women’s Perceptions of Breastfeeding One of the main concerns women have regarding breastfeeding is the uncertainty of the amount of milk their baby is receiving. Formula bottles have precise markings which allow mum to know the exact amount of milk being consumed. Breastfeeding is less precise. The only way of knowing if baby is taking in sufficient amounts is to weigh them on a regular basis. Fears that the infant is not taking in enough milk is the main reason given by mothers for switching to the bottle when the baby is from one week to four months old (Hamlyn et al, 2002: 134). Other reasons include perceptions of cultural attitudes regarding breastfeeding and advertising campaigns that misrepresent formula feeding as the ‘norm.’ This along with inadequate public facilities for mothers to breastfeed their baby add to the reluctance to continue the natural feeding process past the first few weeks or months of life (“Promotiing”, 2000). “A major reason for early cessation is the mothers’ perceived difficulty with breastfeeding rather than maternal choice” (Dykes & Williams, 1999). According to a UK study, mothers who perceived that they lacked adequate information regarding or problems beginning breastfeeding were not as likely to continue breastfeed exclusively six to 10 weeks following the birth of the child. Perceptions that the public does not generally support or understand the importance of breastfeeding also play a part in early cessation of breastfeeding for many mothers. In today’s highly technological, fast-paced society which has become more accustomed and comfortable with bottle feeding as the ‘norm’, mothers who feed their children by natural means are often viewed as out of the mainstream and are wasting time with such matters. “Until our culture changes and the mother and baby are protected as a unit from social and work pressures that threaten their time together during the first year, many women will give up. They don’t want to be seen as inefficient, unproductive, and time wasting” (Dykes & Williams, 1999). Breastfeeding in the U.K. The percentage of British mothers that breast feed is lower than most other countries in Western Europe. Two-thirds of UK babies are breast fed during the first week of life but just over 50 per cent continue to receive mother’s milk after that first seven days and just over a quarter are breastfeeding at four months of age according to a 2000 government survey. “This compares with Scandinavian countries, such as Norway, where 97 per cent of mothers start off breastfeeding, with 80 per cent still doing so at six months” (O’Reilly, 2002). Though international and national governing bodies, in addition to health care experts, have long advised that children be breast fed through their fourth month at minimum, British women still haven’t seemed to get the message at least to the same extent of their European counterparts (Hamlyn et at, 2002: 134). Every year, 75,000 British women cease breastfeeding following the first week but nearly all (99 per cent) claimed that this was not their original intention. Of the mothers who stopped breastfeeding prior to the fourth month, 80 per cent said that they would have preferred to continue past that point. The justification most often offered by mothers who stopped breastfeeding earlier than they originally planned was that the difficulties they faced, whether perceived or real, could have been solved by a NHS that gave better care and more accessible information (“Breastfeeding”, 2006). Though the government has actively promoted the benefits of breastfeeding for at least two decades, statistics complied by the Office of National Statistics show that approximately the same percentage of mother’s breastfed for similar periods of time in both 1980 and 2000. Surveys compiled in 1995 showed that a greater number of English mothers breast fed (62 per cent) as compared to Welch (48 per cent), Scottish (41 per cent) and Irish (41 per cent). Additionally, social status plays a part in determining the likelihood that mothers will breastfeed. In a somewhat counterintuitive finding, 90 per cent of upper-class (I) UK mothers breastfeed as opposed to just 50 per cent of lower class (V) mothers (“Promoting”, 2000). “Those who do breastfeed tend to be older professional mums who have been through higher education” (O’Reilly, 2002). Many women, especially those of lower class status the evidence shows, do not have adequate access to advice, support systems and information regarding the benefits of breastfeeding. While most all women enjoy similar access to midwife services following the birth of their baby, younger mothers in particular may shy away from asking important questions or soliciting advice concerning breastfeeding. They are also less informed of which questions to ask (Bailey et al, 2002). Health of the Nation Regarding Breastfeeding Usually, societal attitude is the largest obstacle facing breastfeeding women. The National Childbirth Trust, an organisation that advocates higher levels of understanding and support for new mothers and fathers, has documented many situations that show the level of intolerance toward breastfeeding in England. For example, a mother in England was forcibly removed from a park by a police officer because she was exposing herself (breastfeeding) in public. If that woman had been in a Scottish park anyone that attempted to stop her would have been fined up to £2,500. A GP from Birmingham who was breastfeeding her infant at a restaurant table was told that if she wanted to continue, she must do so in the loo. A more egregious but all too common example occurred at the Ideal Homes Exhibition. “A woman breastfeeding was reduced to tears by abuse from a man who also threw her pushchair away and snatched a cushion that she was resting against” (O’Reilly, 2002). Given the documented instances of intolerance directed towards the natural act of breastfeeding, which represent only a small percentage of such occurrences, it is no surprise that the UK falls well behind other countries in this area. Conclusion Finding innovative methods by which to better inform and support breastfeeding should become a higher priority for health care professional, particularly midwives, if mothers are to feel empowered and comfortable enough to do what they know is best for their baby. By offering continuing educational services to expectant mothers and regularly modernising breastfeeding techniques skills would allow mothers to feel more comfortable about their decision to breastfeed. Working to further enlighten the public regarding the personal and social benefits of breastfeeding would greatly enhance support given to mothers that choose to this healthier method of feeding baby. A major challenge for midwives is to separate theory from practise. They should better understand the multi-layered aspects that affect the choice of mothers to breast feed as well as the duration their child receives this superior nutrition. “Too many mothers are left feeling disappointed or inadequate, due to their failure to continue breast-feeding because of minor problems, which can be overcome in advance by warning mothers about the types of difficulties they may encounter and what preventative steps to take” (Robertson & Goddard, 1997). The promotion of breastfeeding by midwives must be associated with institutional initiatives if the UK can expect to draw level to the rest of the industrialised world. For example, in recent years, hospital polices have been considerably modified to better facilitate breastfeeding. Maternity units are now placing child with mother following birth instead of locating them in different rooms. The NHS and health care providers have also began a campaign to target young mothers in the early stages of pregnancy and providing them information designed to ease the societal and perceived constrains of breastfeeding (“Investing”, 2001). To enhance the overall knowledge of the benefits of breastfeeding, institutional policies whether governmental or health-related should focus on first-time, teenage and low-income mothers, those who are most at-risk for not fully understanding the health consequences involved with breastfeeding. Suggestions to meet this need include information being distributed in schools to dispel any misconceptions about breastfeeding early-on both in the age of the mother and the pregnancy. Other innovative ideas include enabling “more peer support programmes delivered to pregnant teenagers and young mothers with volunteer telephone and counseling support particularly during the 12 week post partum period” and ensuring “young mothers have contact with women who have successfully breastfed in order to provide positive role models” (Sciacca et al, 1995). Young, low income mothers are the least likely group to breastfeed and should be the first targeted for educational services. The reasons this group does not breastfeed at the same percentage rate of others are many. They cite embarrassment resulting from the early-age pregnancy and therefore are less willing to seek outside assistance. In addition, they have been exposed to a formula-feeding culture without the same opportunity that others enjoy regarding education and information (Shaw et al, 2003). “The provision of tokens for free artificial milk may also act as a disincentive for young and low income mothers to breastfeed their infants” (DHSS, 1999). The Baby Friendly Initiative is the foremost programme for training mothers about the health benefits of breastfeeding within the health care system. However, the courses offered by the Initiative have not as yet been critically evaluated to determine their collective effectiveness (Audit Commission, 1997). National campaigns have utilised mass media outlets to broadcast the advantages of natural feeding such as Breastfeeding Awareness Week which was designed to augment public appreciation of breastfeeding benefits to mother and child. This is a positive step in the right direction but the substantive impact the media projects and the degree it influences societal norms cuts both ways and should be closely monitored. Rather than being obsessed with weighing breastfed infants, fewer but higher quality clinical sessions should be considered with additional time being allocated to discussing individual cases with health care professionals. “Clinic sessions could be rearranged so that each visit does not necessarily include weighing, and the emphasis broadened from the physical outcomes of growth to wider aspects of well-being and breastfeeding effectiveness, as well as satisfaction with the experience” (Sachs et al, 2006). Information and education of the general public as well as health care professional, particularly midwives, is the most important factor in distributing the benefits of breastfeeding. Midwifery is at the forefront of the connection between known good health practises and those who stand to benefit most, mothers and their babies. Given the higher IQ’s and healthier outcomes derived from this natural and ancient feeding method, all of society stands to reap benefits from higher rates of breastfeeding. References Audit Commission. (1997). First Class Delivery. Improving Maternity Services in England & Wales. London: Audit Commission. Bailey, C., Pain, R. & Aarvold, J. (2002). New Mothers’ Experiences of Breastfeeding Support. Available 27 August 2007 from “Breastfeeding.” (2006). UNICEF UK. Available 27 August 2007 from “Definition of the Midwife.” (2003). International Confederation of Midwives. Available 27 August 2007 from DHSS. (1999). Breastfeeding Strategy for Northern Ireland. Belfast: DHSS. Available 27 August 2007 from Dykes F. & Williams C. 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Nottingham: La Leche League International. Available 27 August 2007 from Read More